Evidence-based rules from family practice to inform family practice; The learning healthcare system case study on urinary tract infections

Background: Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Methods: Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. Results: The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis". The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. Conclusions: We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data

A high sensitivity, low noise and high spatial resolution multi-band infrared reflectography camera for the study of paintings and works on paper

Infrared reflectography (IRR) remains an important method to visualize underdrawing and compositional changes in paintings. Older IRR camera systems are being replaced with near-infrared cameras consisting of room temperature infrared detector arrays made out of indium gallium arsenide (InGaAs) that operate over the spectral range of ~900 to 1700 nm. Two camera types are becoming prevalent. The first is staring array infrared cameras having 0.25–1 Megapixels where the camera or painting is moved to acquire tens of individual images that are later mosaicked together to create the infrared reflectogram. The second camera type is scanning back cameras in which a small InGaAs array (linear or area array) is mechanically scanned over a large image formed by the camera lens to create the reflectogram, typically 16 Megapixels. Both systems have advantages and disadvantages. The staring IR array cameras offer more flexible collection formats, provide live images, and allow for the use of spectral bandpass filters that can provide reflectograms with better contrast in some cases. They do require a mechanical system for moving the camera or the artwork and post-capture image mosaicking. Scanning back cameras eliminate or reduce the amount of mosaicking and movement of the camera, however the need to minimize light exposure to the artwork requires short integration times, and thus limits the use of spectral bandpass filters. In general, InGaAs cameras are not sensitive in the 1700 to ~2300 nm spectral region, which has been identified in prior studies as useful for examining paintings with copper green pigments or thick lead white paints. Prior studies using cameras with sensitivity from 1000 to 2500 nm have found in general the performance at wavelengths longer than 1700 nm degraded relative to the performance at shorter wavelengths. Thus, there is interest in a camera system having improved performance out to 2500 nm that can utilize spectral bandpass filters

Food Security in the COVID-19 Era

Food insecurity is a national issue, one that affected 10.5% of households during some point of the year 2019. Those affected by food insecurity can have their access to food jeopardized due to financial hardship, eating patterns altered to prolong the food available, or various other adjustments including reliance on low-cost food, skipping meals, etc. The state of Vermont is not immune to food insecurity, with a rate of 11.3% of households in 2018. The Covid-19 pandemic created an unprecedented shift in daily life, with households having to rapidly adapt to meet newly imposed governmental regulations, including stay at home orders, while maintaining access to food essentials. This changed exacerbated food insecurity in already food-insecure households, while simultaneously creating food insecurity for those previously unaffected. A study focusing on food insecurity in Vermont from March to April 2020 found a 32.3% increase in food insecurity, with 35.5% of food-insecure households being previously food-secure. This change highlighted not only the growing incidence of food insecurity, but also acknowledged the demographic change seen by newly food insecure households. While this increase is dramatic and alarming, to our knowledge there is no research looking at the continuation of these trends regarding the impact of the Covid-19 pandemic on food insecurity in Vermont households. This lack of data indicates a need for continued follow up to best inform governmental agencies on both how Vermont households are being affected, and how regulations during summer & fall 2020 impacted the rise in food insecurity. These data will then provide guidance for future action to combat current and future food insecurity.https://scholarworks.uvm.edu/comphp_gallery/1304/thumbnail.jp

Assessment of multispectral and hyperspectral imaging systems for digitisation of a Russian icon

In a study of multispectral and hyperspectral reflectance imaging, a Round Robin Test assessed the performance of different systems for the spectral digitisation of artworks. A Russian icon, mass-produced in Moscow in 1899, was digitised by ten institutions around Europe. The image quality was assessed by observers, and the reflectance spectra at selected points were reconstructed to characterise the icon’s colourants and to obtain a quantitative estimate of accuracy. The differing spatial resolutions of the systems affected their ability to resolve fine details in the printed pattern. There was a surprisingly wide variation in the quality of imagery, caused by unwanted reflections from both glossy painted and metallic gold areas of the icon’s surface. Specular reflection also degraded the accuracy of the reconstructed reflectance spectrum in some places, indicating the importance of control over the illumination geometry. Some devices that gave excellent results for matte colour charts proved to have poor performance for this demanding test object. There is a need for adoption of standards for digitising cultural heritage objects to achieve greater consistency of system performance and image quality.This article arose out of a Short-Term Scientific Mission (STSM) conducted by Tatiana Vitorino when visiting University College London during a 2-week period in late October 2015. The research was carried out under the auspices of the European COST Action TD1201 Colour and Space in Cultural Heritage (COSCH). The project website is at http://www.cosch.info. Under the COST rules, TV received funding for travel and accommodation expenses, and all coauthors were able to claim travel expenses to attend the subsequent COSCH project meeting. No other funding was received from COSCH for labour or equipment and all work was done on a voluntary pro bono basis.info:eu-repo/semantics/publishedVersio

MHD models of Pulsar Wind Nebulae

Pulsar Wind Nebulae (PWNe) are bubbles or relativistic plasma that form when the pulsar wind is confined by the SNR or the ISM. Recent observations have shown a richness of emission features that has driven a renewed interest in the theoretical modeling of these objects. In recent years a MHD paradigm has been developed, capable of reproducing almost all of the observed properties of PWNe, shedding new light on many old issues. Given that PWNe are perhaps the nearest systems where processes related to relativistic dynamics can be investigated with high accuracy, a reliable model of their behavior is paramount for a correct understanding of high energy astrophysics in general. I will review the present status of MHD models: what are the key ingredients, their successes, and open questions that still need further investigation.Comment: 18 pages, 5 figures, Invited Review, Proceedings of the "ICREA Workshop on The High-Energy Emission from Pulsars and their Systems", Sant Cugat, Spain, April 12-16, 201

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

BACKGROUND: Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. METHODS: One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. RESULTS: One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). CONCLUSIONS: There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods

Long-Term Surgical Recurrence, Morbidity, Quality of Life, and Body Image of Laparoscopic-Assisted vs. Open Ileocolic Resection for Crohn’s Disease: A Comparative Study

PurposeSeveral studies have compared conventional open ileocolic resection with a laparoscopic-assisted approach. However, long-term outcome after laparoscopic-assisted ileocolic resection remains to be determined. This study was designed to compare long-term results of surgical recurrence, quality of life, body image, and cosmesis in patients who underwent laparoscopic-assisted or open ileocolic resection for Crohn's disease.MethodsSeventy-eight consecutive patients who underwent ileocolic resection during the period 1995 to 1998 were analyzed; 48 underwent a conventional open approach in the Academic Medical Centre (Amsterdam, The Netherlands) and 30 underwent a laparoscopic-assisted approach in the Leiden University Medical Centre (Leiden, The Netherlands). Primary outcome parameters were reoperation and readmission rate. Secondary outcome parameters were quality of life, body image, and cosmesis.ResultsThe two groups were comparable for characteristics of sex, age, and immunosuppressive therapy. Seventy-one patients had a complete follow-up of median 8.5 years. Resection for recurrent Crohn's disease was performed in 6 of 27 (22 percent) and 10 of 44 (23 percent) patients in the laparoscopic and open groups, respectively. Reoperations for incisional hernia were only performed after conventional open ileocolic resection (3/44 = 6.8 percent). Quality of life and body image were comparable, but cosmesis scores were significantly higher in the laparoscopic group.ConclusionsDespite small numbers, we found that surgical recurrence and quality of life after laparoscopic-assisted and open ileocolic resection were comparable. Incisional hernias occurred only after open ileocolic resection, and laparoscopic-assisted ileocolic resection resulted in a significantly better cosmesis

Conspiracy theory as spatial practice: the case of the Sivas arson attack, Turkey

This article discusses the relationship between conspiratorial thinking and physical space by focusing on the ways conspiracy theories regarding political violence shape and are shaped by the environments in which it is commemorated. Conspiratorial thinking features space as a significant element, but is taken to do so mainly figuratively. In blaming external powers and foreign actors for social ills, conspiracy theorists employ the spatial metaphor of inside versus outside. In perceiving discourses of transparency as the concealment rather than revelation of mechanisms of governance, conspiracy theorists engage the trope of a façade separating the space of power’s formulations from that of its operations. Studying the case of an arson attack dating from 1990s Turkey and its recent commemorations, this article argues that space mediates conspiracy theory not just figuratively but also physically and as such serves to catalyze two of its deadliest characteristics: anonymity and non-linear causality. Attending to this mediation requires a shift of focus from what conspiracy theory is to what it does as a spatial practice

MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?

Histopathological audit of positive circumferential resection margins (CRMs) can be used as a surrogate measure of the success of rectal cancer treatment. We audited CRM involvement in rectal cancer patients and the impact of the multidisciplinary team (MDT) on implementing a magnetic resonance imaging (MRI)-based preoperative treatment strategy. Data were collected on all newly diagnosed rectal cancer patients treated in our network between January 1999 and December 2002. Data were analysed for MRI prediction and histopathological assessment of CRM together with the MDT meeting treatment decisions. The CRM+ve rate of those discussed at MDT vs those not discussed were compared. We re-audited the CRM+ve rates 1 year after introducing a policy of mandatory preoperative MRI-based MDT discussion. Of the 298 patients diagnosed with rectal cancer, 39 (13%) were deemed palliative, 178 underwent surgery alone and 81 underwent neoadjuvant therapy. Of these, 62 out of 178 patients underwent surgery alone without MRI-based MDT discussion resulting in positive CRM in 16 cases (26%) as compared to 1 out of 116 (1%) in those patients with MDT discussion of MRI. Overall CRM+ve rate in all nonpalliative patients with or without MDT discussion was 12.5% (32 out of 256), significantly lower than the <20% rate (P<0.001) quoted in national guidelines. Re-audit in 98 consecutive patients following a change of policy produced a lower CRM+ve rate of 3% (1 out of 37) for all surgery alone patients and an overall CRM+ve rate of 7% (5 out of 70). In conclusion, MDT discussion of MRI and implementation of a preoperative treatment strategy results in significantly reduced positive CRM in rectal cancer patients